Epidemiology and Public Health Science: Core Competencies for

Epidemiology and Public Health Science: Core Competencies for

High School Students

Kelly L. Cordeira, MPH1,2 and Ralph Cordell, PhD1

1Career Paths to Public Health; Division of Scientific Education and Professional Development;

Center for Surveillance, Epidemiology and Laboratory Services; Centers for Disease Control and Prevention

2Association of Schools and Programs of Public Health Fellowship Program

Epidemiology and Public Health Science: Core competencies for high school students was developed as a resource for teachers interested in teaching epidemiology and public health science. It is a Career Paths to Public Health product in the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Office of Public Health Scientific Services, Centers for Disease Control and Prevention.

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Acknowledgements We appreciate the support of experts in both public health and education, including master teachers from around the United States, who have reviewed these competencies for content, classroom usability, and alignment with other educational resources. Their input has been ongoing and invaluable to the development of this product. Suggested citation Centers for Disease Control and Prevention (CDC). Epidemiology and Public Health Science: Core Competencies for High School Students. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. Contact Information Please send questions and comments to [email protected]

Disclaimers

These core competencies for high school students are in the public domain and may be used without restriction. Citation as to source, however, is appreciated.

Links to nonfederal organizations are provided solely as a service to our users. These links do

not constitute an endorsement of these organizations nor their programs by the Centers for Disease Control and Prevention (CDC) or the federal government, and none should be

inferred. CDC is not responsible for the content contained at these sites. URL addresses listed were current as of the date of publication.

Use of trade names and commercial sources is for identification only and does not imply

endorsement by the Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and

Prevention, the Public Health Service, or the U.S. Department of Health and Human Services.

The findings and conclusions in this document are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

mailto:[email protected]

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Career Paths to Public Health Career Paths to Public Health’s (CPP) mission is to improve future workforce capacity by raising awareness, igniting interest, and developing competency in epidemiology and public health science (EPHS) among secondary school students as a means to increase health literacy and advance students into a public health career pathway at an early age. Purpose of EPHS Core Competencies Public health is among the fastest growing undergraduate fields in the nation.1 A growing interest in public health at the middle and high school levels has been noted.2-4 Secondary school curricula in public health are needed to develop basic public health competencies and allow for a smooth transition to college-level coursework. Early experiences in the field may increase the likelihood of students pursuing a public health career during later years.5,6 Substantial value in secondary school education in public health regardless of career path trajectories has also been reported. Public health education has the potential to expose students to crosscutting public health concerns with immediate relevance. This supports development of knowledge and critical thinking skills across public health domains and other disciplines, such as physical and natural sciences, social and behavioral sciences, mathematics and quantitative reasoning, and the humanities.3 Students will be exposed to concepts and experiences that support information and science literacy, ultimately leading to a informed generation regarding public health. CPP developed EPHS core competencies to support high school teachers and administrators in creating EPHS-based curricula and proposals to accredit EPHS as an elective course in schools, districts, and states. Experts in both public health and education, including master teachers from around the United States have reviewed these competencies for content, usability in the classroom, and alignment with other educational resources. Organization of Core Competencies The core competencies are based on four core public health domains (i.e., epidemiology, surveillance, analytic epidemiology, and prevention effectiveness), which provide the foundation for a humanities perspective (i.e., a public health approach). Each domain has 3–4 core competencies supplemented with a clarification statement. The clarification statements provide content and skill information needed to meet each competency. Domains

• EPHS1: Epidemiologic Thinking and a Public Health Approach • EPHS2: Public Health Surveillance • EPHS3: Analytic Epidemiology • EPHS4: Prevention Effectiveness

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Alignment of Core Competencies EPHS core competencies are based on the enduring understandings of epidemiology7, and align with Next Generation Science Standards (NGSS) (http://www.nextgenscience.org/)*,8, and the Association of Schools and Programs of Public Health (ASPPH) Recommended Critical Component Elements of an Undergraduate Major in public health (http://www.aspph.org/educate/models/undergraduate-baccalaureate-cce-report/).9 These associations provide both vertical and horizontal connectivity and assure that these competencies provide a foundation for future studies and are firmly grounded in the discipline and pedagogy. (See Figure 1). See appendices for detailed alignment.

Figure 1: Alignment of Epidemiology and Public Health Core Competencies for High School Students with Next Generation Science Standards*, Common Core, Enduring Understandings of Epidemiology, and ASPPH Recommended Critical Component Elements of an Undergraduate Major in Public Health.

Source: Career Paths to Public Health, Centers for Disease Control and Prevention.

* Next Generation Science Standards is a registered trademark of Achieve. Neither Achieve nor the lead states and partners thatdeveloped the Next Generation Science Standards was involved in the production of, and does not endorse this product.

http://www.nextgenscience.org/

http://www.aspph.org/educate/models/undergraduate-baccalaureate-cce-report/

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Enduring Understandings of Epidemiology EPHS core competencies are based primarily on 12 fundamental or enduring epidemiologic understandings developed by Kaelin and coworkers.7 Twenty-eight judges for the Robert Wood Johnson Foundation and College Board’s Young Epidemiology Scholars (YES) Competition were surveyed and developed a consensus concerning major concepts and principles around which epidemiology teachers at the high school level should structure their curricula. These were further consolidated into four EPHS domains with 14 new core competencies that align with both NGSS (high school) and the ASPPH Recommended Critical Component Elements of an Undergraduate Major in Public Health. See Appendix 1 for a detailed alignment of the enduring understandings of epidemiology with EPHS core competencies. Next Generation Science Standards* (High School) EPHS core competencies align with high school science and engineering practices and crosscutting concepts used in NGSS. NGSS was developed on the basis of research from the National Research Council, A Framework for K-12 Science Education: Practices, Crosscutting Concepts, and Core Ideas10, and was published in 2013. These evidence-based standards propose a shift in teaching pedagogy from just learning about science to teaching students how to actually do science. Teachers can use these standards to engage students in critical thinking concerning science by using discipline-specific core content, eight science and engineering practices (e.g., gathering, reasoning, and communicating) and seven crosscutting concepts (e.g., causality, patterns, and systems).8 Practices and crosscutting concepts were considered in the development of EPHS core competencies. Each competency emphasizes 1–2 specific skills and ideas. In NGSS, core content was also identified for each discipline and includes performance expectations for each content area. To align with NGSS, core content for EPHS was identified. The majority of content is based on Principles of Epidemiology in Public Health Practice11, a widely used CDC self-study program for those working in public health. Ten content areas (e.g., epidemiologic thinking, surveillance, study designs, and intervention strategies) were identified and defined. These content areas and definitions were used to develop the clarification statements for each performance expectation. Alignment with NGSS in a similar visual format and language is available in Appendix 2. ASPPH Critical Component Elements of an Undergraduate Major in Public Health EPHS core competencies vertically align with the recommended critical component elements of an undergraduate major in public health. In 2012, ASPPH published key components by discipline, skill area, public health content area, and crosscutting areas.9 EPHS core competencies for high school students focus on developing a necessary foundation to achieve standards at the undergraduate level. EPHS core competencies, overall, incorporate four ASPPH disciplines (i.e., science, social and behavioral sciences, mathematics and quantitative reasoning, and humanities and fine arts); two ASPPH skills areas (i.e., communication, information literacy); seven of nine ASPPH public health content areas with a focus on four (i.e., overview of public health, role and importance of data in public health, determinants of health, and health communication); and eight ASPPH crosscutting areas with an emphasis on critical thinking and creativity, organizational dynamics, research methods, and systems thinking. Alignment with undergraduate critical components is available in Appendix 3.

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Epidemiology and Public Health Science (EPHS): Core Competencies for High School Students

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EPHS 1: Epidemiologic Thinking and a Public Health Approach This domain supports students’ understanding of the broad picture of epidemiology and public health science and how it influences health and disease. Students can make connections among the causes of health and disease through epidemiologic thinking, and learn how a public health approach is used to improve health and prevent disease. The focus of this disciplinary core idea is concerning interdependencies of epidemiology and public health action over time, while considering the historical evolution of epidemiology. HS-EPHS 1: Epidemiologic Thinking and a Public Health Approach Competency Clarification Statement HS-EPHS1-1 Describe how epidemiologic thinking is used to

provide an evidence-based explanation concerning causes and correlations of health and disease.

Emphasis is on describing what basic epidemiology is, how it has evolved and how it is used today, and the key methods and concepts of epidemiology.

HS-EPHS1-2 Discuss how epidemiologic thinking and a public health approach is used to transform a narrative into an evidence-based explanation.

Emphasis is on examining scientific literature to identify core methodology used and applied in different circumstances. Students examine steps used in outbreak investigations and explain how circumstances of an outbreak can dictate a different order be followed.

HS-EPHS1-3

Apply epidemiologic thinking and a public health approach to a model (e.g., outbreak) to explain cause and effect associations that influence health and disease.

Emphasis is on how epidemiologic thinking and methods are tailored to investigate specific health-related factors, provide evidence for their influence, and propose public health interventions.

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EPHS2: Public Health Surveillance Through identifying patterns of health and disease and formulating hypotheses, students learn how to define health problems through surveillance, identify sources and methods for gathering data, and conduct descriptive epidemiology. By examining characteristics of health and disease, including person, place, and time, students generate hypotheses and identify testable associations for study. HS-EPHS 2: Public Health Surveillance Competency Clarification Statement HS-EPHS2-1

Describe how to collect reliable data regarding priority health-related phenomena using public health surveillance systems.

Emphasis is on identifying priority health-related phenomena according to importance of the problem; ability to prevent, control, or treat the problem; and capacity of the health system to implement control measures for the health problem. Also consider how data is collected in determining which type of surveillance system (i.e., active, passive) is used.

HS-EPHS2-2

Use credible evidence to surveillance system.

describe a public health Emphasis is on describing a surveillance system and its attributes (e.g., simplicity, flexibility, data quality, stability, acceptability, sensitivity, predictive value positive, representativeness, timeliness) qualitatively and quantitatively.

HS-EPHS2-3

Use models (e.g., mathematical models, and figures) that are based on empirical evidence identify patterns of health and disease to characterize a public health problem.

to Emphasis is on identification of patterns using basic mathematical models (e.g., frequency measures) and figures (e.g., epi curves, graphs, maps) to describe health-related occurrences by person, place, and time.

HS-EPHS2-4

Use patterns in empirical evidence to hypotheses.

formulate Emphasis is on using descriptive epidemiology, what is known concerning health-related phenomena, and what others have postulated in historical or current contexts to develop testable hypotheses.

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EPHS3: Analytic Epidemiology Students test hypotheses by making group comparisons and providing mathematical evidence for associations between exposure and disease. Then, students explain associations and judge causation on the basis of this evidence. Key aspects of analytic epidemiology, including study design, causality, and other explanations of evidence (e.g., bias, chance, confounding), are targeted. The performance expectations focus on identifying appropriate study designs with considerations of the scope and limitations of each, conducting appropriate statistical testing to provide mathematical evidence, and interpreting statistical results to determine public health influence. HS-EPHS 3: Analytic Epidemiology Competency Clarification Statement HS-EPHS3-1

Describe the capacity of basic epidemiologic study designs (e.g., cross-sectional, case-control, cohort, and randomized controlled trial) to address hypotheses under different circumstances.

Emphasis is on the time, order and processes for each study design, appropriate design given the circumstances (including strengths and limitations), measure of effect, and role of the epidemiologist.

HS-EPHS3-2

Use empirical data from an experimental study (e.g., clinical trial) to mathematically quantify an association between an exposure and disease.

Emphasis is on identifying the appropriate study design to produce the desired data with the fewest number of limitations. Ability to measure association and public health affect should be considered.

HS-EPHS3-3

Use empirical data from an observational study to mathematically quantify an association between an exposure and disease.

Emphasis is on applying mathematical concepts (e.g., probability, statistics) to measure strength and significance of association between an exposure and outcome. Power, sample size, statistical tests, and ability to determine associations should be considered. Example calculations can include measures of association (e.g. risk ratio, relative risk, odds ratio, and rate ratio) and measures of risk (e.g., attack, incidence, prevalence, and mortality rates).

HS-EPHS3-4

Make a statement concerning an association between an exposure and disease with consideration of a mathematical analysis of empirical data.

Emphasis is on interpreting statistical data to construct explanations regarding strength and significance of an association between an exposure and outcome. Consideration of other explanations of evidence (e.g., bias, chance, and confounding) by other factors (e.g., social, economic, cultural, and environmental) must be made.

HS-EPHS3-5

Make a statement concerning causality with consideration of a mathematical analysis of empirical data and Bradford Hill’s Criteria for Causality.12

Emphasis is on applying probability and statistics to measure strength and significance of association between an exposure and outcome. Consideration of Hill’s Criteria of Causation12 and of other explanations of evidence (e.g., bias, chance, and confounding) by other factors (e.g., social, economic, cultural, and environmental) must be made.

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EPHS4: Prevention Effectiveness The disciplinary core focuses on how the core sciences of public health can be transformed into action to improve health and prevent disease and how different metrics are used to determine effectiveness of those actions. Students consider the dynamic influences of other disciplines concerning public health prevention and control efforts. By identifying priorities, previous patterns of performance, and perspectives from other disciplines, students learn how to systematically design public health policies, programs, and practices and assess their influence. HS-EPHS 4: Prevention Effectiveness Competency Clarification Statement HS-EPHS4-1

Describe a model illustrating how scientific, social, economic, environmental, cultural, and political systems influence intervention performance patterns.

Emphasis is on identifying how ongoing changes in one or multiple systems across disciplines can have variable effects on individual and societal health-related decisions to improve health and prevent disease.

HS-EPHS4-2

Use a targeted health promotion and communication approach (taking into consideration scientific knowledge, the organization of systems and their performance patterns, prioritized criteria, and tradeoff considerations) to design intervention strategies.

Emphasis is on conducting research to determine if an intervention is plausible, applied research to determine if it can work, pilot projects to show that it will work, and actual implementation to show that it does work.

HS-EPHS4-3

Evaluate competing health-related intervention strategies by using a systematic assessment to improve effectiveness.

Emphasis is on program evaluation methods for planning, implementing, and assessing the effect of an intervention, and prevention effectiveness as a systematic assessment of influences of public health policies, programs, and practices on health outcomes.

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Resources 1. Leider JP, Castrucci BC, Plepys CM, et al. Characterizing the growth of the undergraduate public

health major: U.S., 1992-2012. Public Health Rep. 2015;130(1):104-113. 2. Stroup DF, Thacker SB. Epidemiology and education: using public health for teaching mathematics

and science. Public Health Rep. 2007;122(3):283-291. 3. Holm-Delgado MG. Educating epidemiologists throughout the life course: moving from

conversation to action. Ann Epidemiol. 2014;24(3):169-170. 4. Hlaing WM. "Educating epidemiologists" [letter]. Ann Epidemiol. 2014;24(7):558-559. 5. Aschbacher PR, Lee E, Roth EJ. Is science me? High school students' identities, participation and

aspirations in science, engineering, and medicine. J Res Sci Teach. 2010;47(5):564-582. 6. Tai RH, Liu CQ, Maltese AV, Fan X. Career choice: Planning early for careers in science. Science.

2006;312(5777):1143-1144. 7. Kaelin MA, Huebner WW, Cordell RL, Szklarczuk B. Proessional development for prospective

epidemiology teachers in grades 6-12. Public Health Rep. 2008;123(suppl 2):5-11. 8. NGSS Lead States. Next Generation Science Standards: For States, By states. 2013. Available at:

http://www.nextgenscience.org/next-generation-science-standards. Accessed February 9, 2016. 9. Association of Schools and Programs of Public Health. Recommended Critical Component Elements

of an Undergraduate Major in Public Health. 2012. Available at: http://www.aspph.org/wp-content/uploads/2014/04/CCE_2012-08-03-FINAL.pdf. Accessed February 9, 2016.

10. National Research Council. A Framework for K-12 Science Education: Practices, Crosscutting Concepts, and Core Ideas. Washington, DC: National Academies Press; 2011.

11. Centers for Disease Control and Prevention. Principles of Epidemiology in Public Health Practice, Third Edition: An Introduction to Applied Epidemiology and Biostatistics. 2006. Available at: http://www.cdc.gov/ophss/csels/dsepd/SS1978/SS1978.pdf. Accessed February 11, 2016.

12. Hill AB. The environment and disease: Association or causation? Proc R Soc Med. 1965;58(5):295-300.

http://www.aspph.org/wp-content/uploads/2014/04/CCE_2012-08-03-FINAL.pdf


http://www.cdc.gov/ophss/csels/dsepd/SS1978/SS1978.pdf

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Appendices: Supplementary Documents

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Appendix 1: Alignment with Enduring Understandings of Epidemiology1

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Epidemiology and Public Health Science (EPHS): Core competencies for high school students primarily are based on 12 fundamental or enduring epidemiologic understandings (EU) developed by Kaelin and coworkers. These are statements summarize important ideas and core processes central to the discipline, have lasting value beyond the classroom, and represent major concepts and principles around which teachers should structure their teaching. Twenty-eight judges for the Robert Wood Johnson Foundation and College Board’s Young Epidemiology Scholars Competition were surveyed and developed a consensus regarding major concepts and principles around which epidemiology teachers at the high school level should structure their curricula. This document represents a consolidation of these concepts and into four EPHS domains with 15 new core competencies. Table 1: Alignment of CDC’s EPHS Core Competencies for High School Students with the Enduring Understandings of Epidemiology. CDC’s Epidemiology and Public

Health Science (EPHS) Core Competency

Kaelin and coworkers1 Enduring Understanding(s) of Epidemiology

HS-EPHS1-1

Describe how epidemiologic thinking is used to provide an evidence-based explanation concerning causes and correlations of health and disease.

EU 1: The causes of health and disease are discoverable by systematically and rigorously identifying their patterns among populations, formulating causal hypotheses, and testing those hypotheses by making group comparisons. These methods are at the core of the science of epidemiology. Epidemiology is the basic science of public health, a discipline responsible for improving health and preventing disease among populations.

HS-EPHS1-2

Discuss how epidemiologic thinking and a public health approach is used to transform a narrative into an evidence-based explanation.

EU 12: An understanding of phenomena unrelated to health can be developed through epidemiologic thinking, by identifying their patterns in populations, formulating causal hypotheses, and testing those hypotheses by making group comparisons.

HS-EPHS1-3

Apply epidemiologic thinking and a public health approach to a model (e.g., outbreak) to explain cause and effect associations that influence health and disease.

EU 1: The causes of health and disease are discoverable by systematically and rigorously identifying their patterns among populations, formulating causal hypotheses, and testing those hypotheses by making group comparisons. These methods are at the core of the science of epidemiology. Epidemiology is the basic science of public health, a discipline responsible for improving health and preventing disease among populations.

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Table 1, con’t. CDC’s Epidemiology and Public



HS-EPHS2-1

Describe how to collect reliable data regarding priority health-related phenomena by using public health surveillance systems.

EU 2: Health and disease are not distributed haphazardly among a population. Patterns to their occurrence are discernable. These patterns can be identified through the surveillance of populations.

HS-EPHS2-2

Use credible evidence to describe a public health surveillance system.


HS-EPHS2-3

Use models (e.g., mathematical models or figures) that are based on empirical evidence to identify patterns of health and disease to characterize a public health problem.


HS-EPHS2-4

Use patterns in empirical evidence to formulate hypotheses.

EU 3: Analysis of these patterns of health and disease can help formulate hypotheses regarding their possible causes.

HS-EPHS3-1

Describe the capacity of basic epidemiologic study designs (e.g., cross-sectional, case-control, cohort, and randomized controlled trial) to address hypotheses under different circumstances.

EU 4: A hypothesis can be tested by comparing the frequency of disease in selected groups of people with and without an exposure to determine if the exposure and the disease are associated.

HS-EPHS3-2

Use empirical data from an experimental study (e.g., clinical trial) to mathematically quantify an association between an exposure and disease.

EU 6: When an exposure is hypothesized to have a beneficial effect, studies can be designed in which a group of people is intentionally exposed to the hypothesized cause and compared with a group who is not exposed.

HS-EPHS3-3

Use empirical data from an observational study to mathematically quantify an association between an exposure and disease.

EU 4: A hypothesis can be tested by comparing the frequency of disease in selected groups of people with and without an exposure to determine if the exposure and the disease are associated.

EU 5: When an exposure is hypothesized to have a detrimental effect, it is unethical to intentionally expose a group of persons. In these circumstances, studies can be designed that observe groups of free-living people with and without the exposure.

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Table 1, con’t. CDC’s Epidemiology and Public



HS-EPHS3-4

Make a statement concerning an association between an exposure and disease with consideration of a mathematical analysis of empirical data.

EU 7: One possible explanation for finding an association is that the exposure causes the outcome. Because studies are complicated by factors not controlled by the observer, other explanations also must be considered, including chance, bias, confounding, and reverse time order.

HS-EPHS3-5

Make a statement concerning causality with consideration of a mathematical analysis of empirical data and Bradford Hill’s Criteria for Causality.

EU 8: While a given exposure might be necessary to cause an outcome, the presence of a single factor is seldom sufficient. The majority of outcomes are caused by a combination of exposures that can include genetic make-up, behaviors, social, economic, and cultural factors and the environment.

EU 9: Judgment regarding whether an exposure causes a disease is developed by examining a body of epidemiologic evidence as well as evidence from other scientific disciplines.

HS-EPHS4-1

Describe a model illustrating how scientific, social, economic, environmental, cultural, and political systems influence intervention performance patterns.

EU 10: Individual and societal decisions regarding what should be done to improve health and prevent disease are based on more than scientific evidence. Social, economic, ethical, environmental, cultural, or political factors are also considered in decision making.

HS-EPHS4-2

Use a targeted health promotion and communication approach (taking into consideration scientific knowledge, the organization of systems and their performance patterns, prioritized criteria, and tradeoff considerations) to design intervention strategies.

EU 10: Individual and societal decisions regarding what should be done to improve health and prevent disease are based on more than scientific evidence. Social, economic, ethical, environmental, cultural, or political factors are also considered in decision making.

HS-EPHS4-3

Evaluate competing health-related intervention strategies by using a systematic assessment to improve effectiveness.

EU 11: The effectiveness of a health-promoting strategy can be evaluated by comparing the frequency of disease among selected groups of perosns who were and were not exposed to the strategy. Costs, trade-offs, and alternative solutions must also be considered in evaluating the strategy.

Resource for Appendix 1 1. Kaelin MA, Huebner WW, Cordell RL, Szklarczuk B. Proessional development for prospective

epidemiology teachers in grades 6-12. Public Health Rep. 2008;123(suppl 2):5-11

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Appendix 2: Alignment with the Next Generation Science Standards*,1

Epidemiology and Public Health Science (EPHS): Core competencies for high school students align with the Next Generation Science Standards (NGSS) by incorporating three dimensions, including content, practices, and crosscutting concepts within each EPHS domain (i.e., disciplinary core area). The National Research Council’s (NRC) framework for K-12 Science education describes these dimensions in detail, emphasizing that proficiency in science is learned though examination of evidence and its context, the development of models and theories, and the ongoing revision of knowledge derived from these methods of science.2

CDC Epidemiology and Public Health Science Disciplinary Core Content CPP identified EPHS disciplinary core content. To teach public health at the high school level, the majority of content was derived from Principles of Epidemiology in Public Health Practice, Third Edition3, a CDC document developed as an introductory course for public health professionals, and tailored for the purpose of these competencies. Core content includes

• epidemiologic thinking, • measures of association, • public health approach, • causation, • public health surveillance, • influencing systems, • descriptive epidemiology, • intervention strategies, and • epidemiologic study designs, • prevention effectiveness.

NGSS Science and Engineering Practices4 and Crosscutting Concepts5

Practices and concepts were adapted from the NRC Framework2 and NGSS1 to provide consistency and increase usability, acceptability, and usefulness. As states adopt NGSS, resources for teachers are being published regarding how to translate NGSS standards into coursework on the basis of the given format. To follow with this trend, EPHS standards are presented in the same visual format and use similar language in this supplementary document. Practices describe a key set of cognitive, social, and physical behaviors that students should actively engage in during science-based lessons. NGSS practices include

• asking questions and defining problems, • constructing explanations and designing • developing and using models, solutions, • planning and carrying out investigations, • engaging in argument from evidence, and • analyzing and interpreting data, • obtaining, evaluating, and communicating • using mathematics and computational thinking, information.

Crosscutting concepts encourage students to associate interrelated knowledge and practices from different domains of science to better conceptualize a broad view of public health and its influences. EPHS competencies do not include energy and matter. NGSS key crosscutting concepts include

• patterns, • energy and matter, • cause and effect, • structure and function, and • scale, proportion, and quantity, • stability and change. • systems and system models,

*Next Generation Science Standards is a registered trademark of Achieve. Neither Achieve nor the lead states and partners that developed the Next Generation Science Standards was not involved in the production of, and does not endorse, this product.

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Table 1: Alignment of CDC EPHS Core Competency Domain: Epidemiologic Thinking and a Public Health Approach with NGSS Science and Engineering Practices and NGSS Crosscutting Concepts1 and CDC EPHS Core Content.

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HS-EPHS 1: Epidemiologic Thinking and a Public Health Approach

Students who demonstrate competency can:

HS-EPHS1-1 Describe how epidemiologic thinking is used to provide an evidence-based explanation concerning causes and correlations of health and disease.

HS-EPHS1-2 Discuss how epidemiologic thinking and a public health approach is used to transform a narrative into an evidence-based explanation.

HS-EPHS1-3 Apply epidemiologic thinking and a public health approach to a model (e.g., outbreak) to explain cause and effect associations that influence health and disease.

Note: The text highlighted herein refers to the primary alignment of the competency to the dimension: NGSS Science and Engineering Practices (blue), EPHS Disciplinary Core Content (orange), and NGSS Crosscutting Concepts (green). If the text refers to more than one dimension, a colored text box represents the secondary alignment of the competency to the dimension.

NGSS Science and Engineering Practices4

CDC EPHS Disciplinary Core Content3

NGSS Crosscutting Concepts5

Constructing Explanations EPHS 1A. Epidemiologic Cause and Effect and Designing Solutions Thinking • Empirical evidence is requir ed

• Apply scientific ideas, • Epidemiology is the study to differentiate between cause principles, or evidence to (scientific, systematic, or data- and correlation and make provide an explanation o f driven) of the distribution claims about specific cau sesphenomena and solve desi gn (frequency or pattern) and and effects. (HS-ESPH1-1),problems, taking int o determinants (causes or risk (HS-ESPH1-2)account possibl e factors) of health-related states • Cause and effect relationshipsunanticipated effects. (HS- and events (WHO defines health can be suggested and predictedEPHS1-1) as “state of complete physical, for complex natural and

mental and social well-being human designed systems byObtaining, Evaluating and and not merely the absence of examining what is known

Communicating disease or infirmity”) in about smaller scaleInformation specified populations (patient is mechanisms within the

• Critically read scientific community, persons viewed system. (HS-ESPH1-3)literature adapted for collectively), and theclassroom use to determine application of (sincethe central ideas or epidemiology is a disciplineconclusions or to obtain within public health) this studyscientific or technical to the control of healthinformation to summarize problems. (HS-EPHS1-1)complex evidence, concepts, • Epidemiology is devoted toprocesses, or information identifying factors that influencepresented in a text by risk for disease amongparaphrasing them in simpler populations. This is analogousbut still accurate terms. (HS- to making a diagnosis in clinicalESPH1-2) medicine. The goal is to identify

epidemiologic thinking provide an evidence-basedexplanation causes and correlations

Discussevidence-based explanation

epidemiologic thinking public health approach model (e.g.,outbreak) to explain cause and effect associations

epidemiologic thinking public health approach

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• Communicate scientific or a cause so that appropriate technical information or public health action might be ideas (e.g., phenomena or th e taken. (HS-EPHS1-1), (HS-process of development a nd EPHS1-2), (HS-EPHS1-3) the design and performance of a proposed process o r EPHS 1B. Public Health system) in multiple forma ts Approach (i.e., orally, graphically, • In public health, four generaltextually, and steps are used to approach amathematically). (HS- problem as follows: surveillanceESPH1-2) (“what is the problem?”); risk

factor identification (“what isDeveloping and Using the cause?”); interventionModels evaluation (“what works?”); and• Develop, revise, or use a implementation (“how do you

model that is based on do it?”. (HS-EPHS1-2), (HS-evidence to illustrate or EPHS1-3)predict relationships between • Steps of an outbreaksystems or between investigation are presented incomponents of a system. conceptual order. In practice,(HS-ESPH1-3) multiple steps can be done at the

same time, or the circumstancesof the outbreak might dictatethat a different order befollowed. (HS-EPHS1-2),(HS-EPHS1-3)

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Table 2: Alignment of CDC EPHS Core Competency Domain: Public Health Surveillance with NGSS Science and Engineering Practices and NGSS Crosscutting Concepts8 and CDC EPHS Core Content.

HS-EPHS2: Public Health Surveillance

Note: The text highlighted in refers to the primary alignment of the competency to the dimension: NGSS Science and Engineering Practices (Blue), EPHS Disciplinary Core Content (Orange), and NGSS Crosscutting Concepts (Green). If the text refers to more than one dimension, a colored text box represents the secondary alignment of the competency to the dimension.

NGSS Science and CDC EPHS NGSS Engineering Practices4 Disciplinary Core Content3 Crosscutting Concepts5

Planning & Carrying out EPHS 2A. Public Health Systems and System Models Investigations Surveillance • Models can be used to predict• Plan and conduct a n • Public health surveillance is the behavior of a system, but

investigation individually and the ongoing, systematic these predictions have limitedcollaboratively to produce data collection, analysis, precision and reliability due toto serve as the basis fo r interpretation, and the assumptions andevidence, and in the design; dissemination of health data to approximations inherent indecide on types, how muc h, help guide public health models. (HS-EPHS2-1)and accuracy of data needed t o decision making and action. • When investigating orproduce reliable (HS-EPHS2-1) describing a system, themeasurements and consider • Criteria for selecting health boundaries and initiallimitations on the precisi on of problems for surveillance conditions of the system needthe data (e.g., number of trials, includes public health to be defined and their inputscost, risk, and time), and importance, ability to prevent and outputs analyzed andrefine the design accordingly. or control the problem, and the described using models. (HS-(HS-EPHS2-1) capacity of the system to EPHS2-2).

• Plan an investigation or test a implement such measures.design individually and (HS-EPHS2-1) Patterns collaboratively to produce data • Passive surveillance occurs • Mathematical representationsto serve as the basis for when data regarding the are needed to identify someevidence as part of building characteristics of diseases are patterns. (HS-EPHS2-3)and revising models, sent to a health agency without • Empirical evidence is neededsupporting explanations for prompting (e.g., registries and to identify patterns. (HS-phenomena, or testing notifications). (HS-EPHS2-2) EPHS2-3), (HS-EPHS2-4)solutions to problems. • Active surveillance occursConsider possible when data regarding theconfounding variables or characteristics of diseases are


HS-EPHS2-1. Describe how to collect reliable data regarding priority health-related phenomena by using public health surveillance systems.

HS-EPHS2-2. Use credible evidence to describe a public health surveillance system.

HS-EPHS2-3. Use models (e.g., mathematical models, and figures) that are based on empirical evidence to identify patterns of health and disease to characterize a public health problem.

HS-EPHS2-4. Use patterns in empirical evidence to formulate hypotheses.

21

effects and evaluate the prompted or solicited (e.g., investigation’s design to surveys). (HS-EPHS2-2) ensure variables are • Surveillance system attributescontrolled. (HS-EPHS2-2) (e.g., simplicity, flexibility,

• Make directional hypotheses data quality, stability,that specify what happens to a acceptability, sensitivity,dependent variable when an predictive value positive,independent variable is representativeness, andmanipulated. (HS-EPHS2-4) timeliness) can be

quantitatively and qualitativelyUsing Mathematics and analyzed to determineComputational Thinking credibility.6 (HS-EPHS2-2)• Use mathematical,

computational, or algorithmic EPHS2 B. Descriptive representations of phenomena Epidemiology or design solutions to describe • Descriptive epidemiologyor support claims or organizes data by time, place,explanations. (HS-EPHS2-2) and person to characterize a

problem, identify populationsEngaging in Argument from at risk, develop hypothesesEvidence regarding risk factors, and• Make and defend a claim target control and prevention

based on evidence about the strategies. (HS-EPHS2-3)natural world or the • Data can be organized by usi ngeffectiveness of a design frequency measures (e.g. ,solution that reflects scientific incidence, prevalence, and knowledge and student- mortality rates) and presente dgenerated evidence. (HS- by using figures (e.g., e piEPHS2-2) curves, graphs, tables, and

maps). (HS-EPHS2-3)Analyzing and Interpreting • Hypotheses, on the basis ofData what is known concerning the• Analyze data using tools, disease, descriptive

technologies, or models (e.g., epidemiology, and what otherscomputational and have postulated, must bemathematical) in order to developed before conducting amake valid and reliable study. (HS-EPHS2-4)scientific claims or determinean optimal design solution.(HS-EPHS2-3)

Asking Questions & Defining Problems • Ask questions that arise from

careful observation ofphenomena, or unexpectedresults, to clarify or seekadditional information, thatarise from examining modelsor a theory, to clarify or seek

22

additional information and relationships, to determine relationships, including quantitative relationships, between independent and dependent variables, and to clarify and refine a model, an explanation, or an engineering problem. (HS-EPHS2-4)

Table 3: Alignment of CDC EPHS Core Competency Domain: Analytic Epidemiology with NGSS Science and Engineering Practices and NGSS Crosscutting Concepts8 and CDC EPHS Core Content.

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HS-EPHS3: Analytic Epidemiology


HS-EPHS3-1. Describe the capacity of basic epidemiologic study designs (e.g., cross-sectional, case-control, cohort, and randomized controlled trial) to address hypotheses under different circumstances.

HS-EPHS3-2. Use empirical data from an experimental study (e.g., community or clinical trial) to mathematically quantify an association between an exposure and disease.

HS-EPHS3-3. Use empirical data from an observational study to mathematically quantify an association between an exposure and disease.

HS-EPHS3-4. Make a statement concerning an association between an exposure and disease with consideration of a mathematical analysis of empirical data.

HS-EPHS3-5. Make a statement concerning causality with consideration of a mathematical analysis of empirical data and Bradford Hill’s Criteria for Causality13.



CDC EPHS Disciplinary Core Content3

Analyzing and Interpreting Data

• Consider limitations of dataanalysis (e.g., measurement error and sample selection) when analyzing and interpreting data. (HS-EPHS3- 1)

• Compare and contrast varioustypes of data sets (e.g., self-generated and archival) to examine consistency of measurements and observations. (HS-EPHS3-1)

• Apply concepts of statistics anprobability (including determining function fits to data, slope, intercept, and correlation coefficient for lineafits) to scientific and engineering questions and

EPHS3 A. Epidemiologic Study Systems Designs • Systems can be designed to

• In an experimental study (e.g., do specific tasks. (HS-clinical trials), an epidemiologist EPHS3-1) controls the exposure (usually by random assignment to exposed Scale, Proportion, and or unexposed groups) of each Quantity person or community, and then • Algebraic thinking is usedtracks the persons or to examine scientific data communities over time to detect and predict the effect of a effects of the exposure. (HS- change in one variable on EPHS3-1), (HS-EPHS3-2) another. (HS-EPHS3-2),

• In an observational study (e.g., (HS-EPHS3-3), (HS-cohort, case-control, and cross- EPHS3-5)

d sectional), participants unknowingly determine their exposure status and the epidemiologist only records

r exposure and illness data. (HS-EPHS3-1), (HS-EPHS3-3)

• In a cohort study, enrollment isbased on status of exposure to a


24

problems, using digital tools. certain factor or membership in a (HS-EPHS3-4), (HS-EPHS3-5) certain group. Populations are

followed, and disease, death, or Using Mathematics and other health-related outcomes

Computational Thinking are documented and compared. • Create or revise a (HS-EPHS3-1), (HS-EPHS3-3)

computational model or • In a case-control study, a groupsimulation of a phenomenon, of persons with a certain disease,designed device, process, or chronic condition, or type ofsystem. (HS-EPHS3-2), (HS- injury (case-patients) and aEPHS3-3) group of persons without the

• Use mathematical, health problem (control subjects)computational, or algorithmic and differences in exposures,representations of phenome na behaviors, and otheror design solutions to descri be characteristics are compared toor support claims or identify and quantifyexplanations. (HS-EPHS3-2), associations, test hypotheses,(HS-EPHS3-3) and identify causes. (HS-

• Apply techniques of algebra EPHS3-1), (HS-EPHS3-3)and functions to represent and • In a cross-sectional study, asolve scientific and engineering sample of persons from aproblems. (HS-EPHS3-2), (HS- population are enrolled and theirEPHS3-3) exposures and health outcomes

• Use simple limit cases to test are measured simultaneously.mathematical expressions, (HS-EPHS3-1), (HS-EPHS3-3)computer programs, algorithms,or simulations of a process or EPHS3 B. Measures of system to see if a model Association “makes sense” by comparing • A measure of association (e.g.,the outcomes with what is risk, rate, odds ratio) quantifiesknown about the real world. the association between an(HS-EPHS3-2), (HS-EPHS3-3) exposure and a particular health

• Apply ratios, rates, percentages, problem. (HS-EPHS3-2), (HS-and unit conversions in the EPHS3-3), (HS-EPHS3-4)context of complicated • A risk ratio compares risk for ameasurement problems health event among one groupinvolving quantities with with the risk among anotherderived or compound units group. It does so by dividing the(e.g., mg/mL, kg/m3, and acre- risk (incidence proportion, attackfeet). (HS-EPHS3-2), (HS- rate) in group 1 by the riskEPHS3-3) (incidence proportion, attack

rate) in group 2. (HS-EPHS3-2),Planning and Carrying out (HS-EPHS3-3), (HS-EPHS3-4)Investigations • An odds ratio is the ratio of the• Plan and conduct an odds of exposure in a group with

investigation or test a design the condition under study andsolution in a safe and ethical the odds of exposure in a groupmanner including without the condition. Itconsiderations of quantifies the associationenvironmental, social, and between an exposure and health

25

personal impacts. (HS-EPHS3- outcome and is the measure of 2) choice in a case-control

• Select appropriate tools to study.(HS-EPHS3-2), (HS-collect, record, analyze, and EPHS3-3), (HS-EPHS3-4) evaluate data. (HS-EPHS3-2)

EPHS3 C. Causation

Constructing Explanations and • Attributable proportion andDesigning Solutions vaccine efficacy are measures of• Make a quantitative or public health effects. They

qualitative claim regarding the identify an association betweenrelationship between dependent an exposure and a disease. (HS-and independent variables. EPHS3-2), (HS-EPHS3-3), (HS-(HS-EPHS3-4), (HS-EPHS3-5) EPHS3-5)

• Hill’s Criteria for Causation7 areEngaging in Argument from a group of conditions useful toEvidence providing evidence for a causal• Make and defend a claim based association. They include

on evidence about the natural strength of association,world or the effectiveness of a consistency of findings,design solution that reflects specificity, temporality,scientific knowledge and biological gradient, plausibility,student-generated evidence. coherence, experiment, and(HS-EPHS3-4), (HS-EPHS3-5) analogy. (HS-EPHS3-5)

.

Table 4: Alignment of CDC EPHS Core Competency Domain: Prevention Effectiveness with NGSS Science and Engineering Practices and NGSS Crosscutting Concepts8 and CDC EPHS Core Content.

EPHS4: Prevention Effectiveness Students who demonstrate competency can:

HS-EPHS4-1. Describe a model illustrating how scientific, social, economic, environmental, cultural, and political systems influence intervention performance patterns.

HS-EPHS4-2. Use a targeted health promotion and communication approach (taking into consideration scientific knowledge, the organization of systems and their patterns of performance, prioritized criteria, and tradeoff considerations) to design intervention strategies.

HS-EPHS4-3. Evaluate competing health-related intervention strategies by using a systematic assessment to improve effectiveness.



Developing and Using Models • Develop, revise, or use a model

based on evidence to illustrate or predict the relationship sbetween systems or between components of a system. (HS-EPHS4-1)

Constructing Explanations and Designing Solutions • Design, evaluate, or refin e a

solution to a complex real-world problem, based on scientific knowledge, student-generated sources of eviden ce,prioritized criteria, and tradeoff considerations. (HS-EPHS4-2)

Engaging in Argument from Evidence • Evaluate competing design

solutions to a real-world problem based on scientific ideas and principles, empiri calevidence, or logical arguments regarding relevant factors (e.g.

CDC EPHS Disciplinary Core Content8-10


Patterns • Patterns of performance of

designed systems can b eanalyzed and interpreted toreengineer and improve the system. (HS-EPHS4-1),(HS-EPHS4-3)

• Classifications o rexplanations used at one scale may fail or need revision when information from smaller or larger scales is introduced, t husrequiring improved investigations and experiments. (HS-EPHS4- 1), (HS-EPHS4-2), (HS-EPHS4-3)

Cause and Effect • Changes in systems ma y

have various causes th atmay not have equal effects.(HS-EPHS4-1)

Systems and System Models

EPHS4 A. Influencing Systems8

• Questions decision makers need answered regarding what should be done to improve health and prevent disease involve multip ledisciplines and perspectives.(HS-EPHS4-1)

• Studies of the same problem within the same discipline ofte ngive different and sometimes conflicting answers. Meta-analysis systematically pool sresults and generates summaries.(HS-EPHS4-1)

• Studies of the same problem indifferent disciplines havedifferent measures. No singlefundamental theoreticalframework to resolve conflictsacross disciplines is available.(HS-EPHS4-1)

EPHS4 B. Intervention Strategies9

• Intervention strategies u seresearch to determine if prevention is plausible; applied

26

27

economic, societal, ethical research to determine if it can • Systems can be designed toconsiderations). (HS-EPHS4-3) work; pilot projects to show that do specific tasks. (HS-

it does work; and actual EPHS4-2)implementation to show that it continues to work. (HS-EPHS4- Structure and Function 2) • Investigating or designing

• Intervention strategies for health new systems or structuresproblems might be clinical, requires a detailedbehavioral, environmental or a examination of thecombination of the three. (HS- properties of differentEPHS4-2) materials, the structures of

• Intervention outcomes can be different components, andmeasured quantitatively by using connections of componentsepidemiologic methods or to reveal its function. (HS-qualitatively by examining the EPHS4-2), (HS-EPHS4-3)distributional, legal, ethical orsocial effects. (HS-EPHS4-2)

EPHS4 C. Prevention Effectiveness

• Prevention effectiveness is thesystematic assessment of theeffect of public health policies,programs, and practices onhealth outcomes. Modeling andmethods determine efficacy,effectiveness, efficiency, andcost of public health services,policies, and interventions.Research facilitates betterdecision-making regarding theallocation of resources accordingto priorities.10 (HS-EPHS4-3)

• Program evaluation uses scientific methods to pla n,implement and assess the effects of policie, programs, and practices. This involves evaluating tasks (i.e., process) ,and impact (i.e., outcomes). Criteria often used to measure the quality of the evaluati oninclude validity, construct validity, internal validity, an dexternal validity.8 (HS-EPHS4-3)

28

Resources for Appendix 2 1. NGSS Lead States. Next Generation Science Standards: For States, By states. 2013. Available at:

http://www.nextgenscience.org/next-generation-science-standards. Accessed February 9, 2016.2. National Research Council. A Framework for K-12 Science Education: Practices, Crosscutting

Concepts, and Core Ideas. Washington, DC: National Academies Press; 2011.3. Centers for Disease Control and Prevention. Principles of Epidemiology in Public Health Practice,

Third Edition: An Introduction to Applied Epidemiology and Biostatistics. 2006. Available at:http://www.cdc.gov/ophss/csels/dsepd/SS1978/SS1978.pdf. Accessed February 11, 2016.

4. NGSS Lead States. Next Generation Science Standards: For States, by States (Appendix F: Scienceand engineering standards). 2013. Available at: http://www.nextgenscience.org/sites/ngss/files/Appendix%20F%20%20Science%20and%20Engineering%20Practices%20in%20the%20NGSS%20-%20FINAL%20060513.pdf. Accessed February 9, 2016.

5. NGSS Lead States. Next Generation Science Standards: For States, By States (Appendix G –Crosscutting Concepts). 2013. Available at: http://www.nextgenscience.org/sites/ngss/files/Appendix%20G%20%20Crosscutting%20Concepts%20FINAL%20edited%204.10.13.pdf.Accessed February 9, 2016.

4. Groseclose SL, German RR, Nsubuga P. Evaluating public health surveillance. In: Lee LM, TeutschSM, Thacker SB, St Louis ME, eds. Principles and Practice of Public Health Surveillance. 3rd ed.New York, NY: Oxford University Press; 2010:166-197.

5. Hill AB. The environment and disease: Association or causation? Proc R Soc Med. 1965;58(5):295-300.

6. Hennessy M. Evaluation. In: Stroup DF, Teutsch SM, eds. Statistics in Public Health: QuantitativeApproaches to Public Health Problems. 1st ed. New York, NY: Oxford University Press; 1998:193-220.

7. Teutsch SM, Harris JR. Introduction. In: Haddix AC, Teutsch SM, Corso PS, eds. PreventionEffectiveness: A Guide to Decision Analysis and Economic Evaluation. 2nd ed. New York, NY:Oxford University Press; 2002:1-10.

8. Centers for Disease Control and Prevention. What is Prevention Effectiveness? CDC Steven M.Teutsch Prevention Effectiveness Fellowship 2009. Available at:http://www.cdc.gov/PEF/WhatIs.html. Accessed February 11, 2016.

http://www.cdc.gov/ophss/csels/dsepd/SS1978/SS1978.pdf

http://www.cdc.gov/PEF/WhatIs.html

Appendix 3: Alignment of CDC’s Epidemiology and Public Health Science High School Core Competencies with ASPPH Critical Component Elements of an Undergraduate Major in Public Health1.

29

Epidemiology and Public Health Science (EPHS): Core competencies for high school students vertically align with the recommended critical component elements of an undergraduate major in public health. In 2012, the Association of Schools and Programs of Public Health (ASPPH) published key components by discipline, skill area, public health content areas, and crosscutting areas1. EPHS core competencies for high school students concentrate on developing a necessary foundation to achieve standards at the undergraduate level. Alignment with undergraduate critical components is displayed in Table 1. Background Diciplines The four background diciplines in the critical components of an undergraduate major include science, social and behavioral sciences, mathematics and quantitative reasoning, and humanities and fine arts. EPHS course was designed to cover all areas, with students first conceptualizing public health through critical methods by using a substantial historical element. Students are then asked to use empirical approaches by using foundations of scientific knowledge, including biological and life sciences and the concepts of health and disease, as well as mathematics and quantitative reasoning to provide evidence to support claims. Throughout this process, practice-based core competencies grounded in social and behavioral sciences are used to explore context of health and disease among populations. Skill Areas Two skill areas were identified for undergraduate students, including communication and information literacy. At the high school level, students are asked to obtain and evaluate materials, such as literature or technical information, and communicate information in multiple formats (i.e., orally, graphically, textually, and mathematically). All core competencies incorporate these two skill areas; further detail of skills can be found in Appendix 2 under “science and engineering practices.” Public Health Content Areas There are nine content areas in the critical components of an undergraduate major in public health. EPHS core competencies for high school student included seven of the nine; however, as a whole, the competencies focus on four: “overview of public health,” role and importance of data in public health,” determinants of health,” and “health communication.” The deliberate use of these content areas provides a foundation of knowledge and experiences in practicing age-level appropriate skills in mathematics and communication. Crosscutting Areas Of the 12 crosscutting areas that undergraduate majors in public health should be exposed to, EPHS core competencies for high school students align with eight. An emphasis is placed on critical thinking and creativity, organizational dynamics, research methods, and systems thinking.

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Table 1: Alignment of Epidemiology and Public Health Science (EPHS) Core Competencies for High School Students with Critical Component Elements of an Undergraduate Major in Public Health9

CDC’s EPHS Core Competencies for High School Students ASPPH Critical Component

Elements of an Undergraduate Major in Public Health1

EPHS

1-1 EPHS

1-2 EPHS

1-3 EPHS

2-1 EPHS

2-2 EPHS

2-3 EPHS

2-4 EPHS

3-1 EPHS

3-2 EPHS

3-3 EPHS

3-4 EPHS

3-5 EPHS

4-1 EPHS

4-2 EPHS

4-3

ASPPH Background Diciplines

Science X X X X X X X X

Social and behavioral sciences X X X X X X X X X X X

Math and quantitative reasoning X X X X X X X

Humanities and fine arts X X X

ASPPH Skill Areas

Communications X X X X X X X X X X X X X X X

Information literacy X X X X X X X X X X X X X X X

ASPPH Public Health Content Areas

Overview of public health X X X X X X X

Role and importance of data in public health

X X X X X X X X X

Identifying and addressing population health challenges

X X X X X

Human health

Determinants of health X X X X X X X X

Project implementation X X

Overview of the health system

Health policy, law, ethics, and economics

X X

Health communication X X X X X X X X

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Table 1, con’t. CDC’s EPHS Core Competencies for High School Students

ASPPH Critical Component Elements of an Undergraduate Major

in Public Health1

EPHS

1-1 EPHS

1-2 EPHS

1-3 EPHS

2-1 EPHS

2-2 EPHS

2-3 EPHS

2-4 EPHS

3-1 EPHS

3-2 EPHS

3-3 EPHS

3-4 EPHS

3-5 EPHS

4-1 EPHS

4-2 EPHS

4-3

ASPPH Crosscutting Areas

Advocacy for protection and promotion of the public’s health at all levels of society.

X X

Community dynamics X X X X

Critical thinking and creativity X X X X X X X X X X X X X X X

Cultural contexts in which public health professionals work

X X

Ethical decision making as related to the self and society

X X

Independent work and a personal work ethic

Networking

Organizational dynamics X X X X X X X X X X X X X

Professionalism

Research methods X X X X X X X X

Systems thinking X X X X X X X X X X X X X X X

Teamwork and Leadership Resource for Appendix 3 1. Association of Schools and Programs of Public Health. Recommended Critical Component Elements of an Undergraduate Major in Public

Health. 2012. Available at: http://www.aspph.org/wp-content/uploads/2014/04/CCE_2012-08-03-FINAL.pdf. Accessed February 9, 2016.
